1174065015 NPI number — ERIN PONTBRIAND COUNSELING LLC

Table of content: (NPI 1174065015)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174065015 NPI number — ERIN PONTBRIAND COUNSELING LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ERIN PONTBRIAND COUNSELING LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1174065015
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/01/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15 YORK ST UNIT 201H
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BIDDEFORD
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04005-5534
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-518-8565
Provider Business Mailing Address Fax Number:
877-366-4620

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15 YORK ST UNIT 201H
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BIDDEFORD
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04005-5534
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-518-8565
Provider Business Practice Location Address Fax Number:
877-366-4620
Provider Enumeration Date:
11/09/2016

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
PONTBRIAND
Authorized Official First Name:
ERIN
Authorized Official Middle Name:
Authorized Official Title or Position:
SOLE OWNER
Authorized Official Telephone Number:
207-518-8565

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  XL4788 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)